Home Drug Guide Rilpivirine

Drug Guide

Generic Name

Rilpivirine

Brand Names Edurant

Classification

Therapeutic: Antiretroviral agent for HIV-1 infection

Pharmacological: Non-nucleoside reverse transcriptase inhibitor (NNRTI)

FDA Approved Indications

  • Treatment of HIV-1 infection in combination with other antiretroviral agents

Mechanism of Action

Rilpivirine binds to reverse transcriptase enzyme and causes direct inhibition of viral DNA synthesis, preventing viral replication.

Dosage and Administration

Adult: 25 mg once daily with a meal

Pediatric: Not approved for pediatric use

Geriatric: No specific recommendations; dose adjustment generally not required, but caution in renal/hepatic impairment

Renal Impairment: No dose adjustment necessary, but use with caution

Hepatic Impairment: Use caution in severe hepatic impairment; no specific dose adjustment established

Pharmacokinetics

Absorption: Well absorbed with food, especially meals containing fat

Distribution: Widely distributed in tissues, plasma protein binding ~99.7%

Metabolism: Primarily via CYP3A enzymes, mainly CYP3A4

Excretion: Metabolized extensively, with minimal unchanged drug excreted in urine and feces

Half Life: ~50 hours

Contraindications

  • Concurrent use with proton pump inhibitors (PPIs) due to decreased absorption and efficacy

Precautions

  • Use with caution in patients with hepatic impairment, history of hypersensitivity, or concomitant medications that prolong QT interval

Adverse Reactions - Common

  • Insomnia (Common)
  • Depressive symptoms (Common)
  • Headache (Common)
  • Nausea (Less common)

Adverse Reactions - Serious

  • QT prolongation, Torsades de Pointes (Rare)
  • Severe skin reactions, including Stevens-Johnson syndrome (Rare)
  • Hepatotoxicity (Rare)

Drug-Drug Interactions

  • Interactions with PPIs reducing efficacy; significant interactions with certain anticonvulsants, rifampin, and herbal products like St. John’s Wort

Drug-Food Interactions

  • High-fat meals increase absorption

Drug-Herb Interactions

  • St. John’s Wort may reduce effectiveness

Nursing Implications

Assessment: Monitor for signs of adverse reactions, adherence, and efficacy of ART

Diagnoses:

  • Risk for ineffective tissue perfusion related to cardiac conduction abnormalities
  • Imbalanced nutrition: less than body requirements due to nausea or anorexia

Implementation: Ensure administration with meal, monitor ECG in patients at risk for QT prolongation, regularly review medication compatibility

Evaluation: Assess viral load and CD4 counts regularly to evaluate treatment effectiveness

Patient/Family Teaching

  • Take medication with a meal to improve absorption
  • Report signs of hypersensitivity, skin rash, or serious side effects promptly
  • Avoid concomitant use of PPIs and discuss any other medications

Special Considerations

Black Box Warnings:

  • QT interval prolongation and risk of Torsades de Pointes

Genetic Factors: Genetic polymorphisms may affect drug metabolism but not routinely tested for

Lab Test Interference: May affect hepatic function tests

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, somnolence, QT prolongation

Treatment: Supportive care, cardiac monitoring, possibly activated charcoal if recent ingestion, no specific antidote

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F) in a dry place

Stability: Stable under recommended storage conditions for the duration of the labeled expiration date

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.